Mesothelioma is treated with surgery, chemotherapy, and radiation. Some patients receive experimental treatments through clinical trials. Mesothelioma patients today have a much higher chance of survival thanks to sophisticated surgical procedures and emerging therapies. There are specialized cancer centers across the country, including within the VA Health Care System.
Mesothelioma treatments accomplish different goals, depending on the particular patient’s case. Specialists tailor mesothelioma treatments according to each patient’s unique diagnosis. Customized treatments give patients the best chance of survival. Each patient has factors that doctors must consider before determining a treatment plan.
Doctors look at following factors to determine best mesothelioma treatment options:
Disease location (pleural, peritoneal or pericardial)
Mesothelioma patients are living longer than ever thanks to tailored treatment plans. Mesothelioma specialists design unique treatment plans for each of their patients.
The primary treatment options for mesothelioma patients include:
Surgeries to remove as much of the tumor as possible
Palliative surgeries that reduce painful symptoms
Chemotherapy that kills cancer cells and prevents them from multiplying
Radiation therapy that targets and destroys cancer cells
Multimodal therapies that use a combination of 2 or more treatment methods
Emerging therapies tested in clinical trials and studies
Surgery offers the best chances of long-term survival for mesothelioma patients. Early-stage patients are the best candidates for surgery. However, patients in all stages of mesothelioma may be eligible. If you aren’t given surgery as an option, consider talking to another doctor. A second opinion from a mesothelioma specialist can save a life.
Doctors have developed different surgical procedures for treating each mesothelioma location.
Here are the main surgical treatments available for many mesothelioma patients:
Extrapleural pneumonectomy (EPP) for pleural mesothelioma
Pleurectomy with decortication (P/D) for pleural mesothelioma
Cytoreduction with HIPEC for peritoneal mesothelioma
Pericardiectomy for pericardial mesothelioma
Palliative surgeries for all mesothelioma types
Extrapleural pneumonectomy (EPP) is a surgery used to treat pleural mesothelioma. During the EPP, the mesothelioma surgeon removes the diseased lung and parts of the chest lining and the heart lining (pericardium). The doctor may also remove a portion of the diaphragm and/or nearby lymph nodes.
Early-stage patients (stage 1 and 2) often receive EPP because of its potential for success. But pleural mesothelioma patients in stages 3 or 4 have benefitted from this treatment too.
The EPP removes the diseased lung and parts of the chest cavity where the cancer has spread. Removing the lung where the majority of the cells exist can improve a patient’s life expectancy.
Did you know?
On average, a patient can double their life expectancy from 12 to 24 months with an EPP. Some patients have gone on to live 5 or more years due to their EPP surgery.
The late Dr. David Sugarbaker was a pioneer for the EPP for pleural mesothelioma. He spent the last 30 years of his life developing this surgery so that more patients can benefit from it. Experts believe survival rates will only continue to improve as specialists refine the EPP technique and increase its success rate.
Pleurectomy With Decortication
Pleurectomy with decortication (P/D) is a used to treat pleural mesothelioma keep their lung. Since it is a lung-sparing surgery, some consider P/D to be a better option compared to EPP.
P/D involves a two-part surgery:
The surgeon performs the “pleurectomy” — removing the diseased pleura (lung lining).
The surgeon begins the “decortication” — removing visible tumor masses in the chest cavity.
Only candidates who are in good enough health to withstand surgery are eligible to receive a P/D. Like EPP, P/D is typically performed on early-stage pleural mesothelioma patients. However, some advanced-stage patients are candidates for P/D.
Dr. Robert Cameron of the UCLA Medical Center developed P/D as an alternative to EPP. Dr. Cameron has spent more than two decades refining the procedure to ensure greater rates of success. As surgeons continue to perfect P/D, they can increase survival rates and save more patient lives.
The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
Though each surgical technique has passionate proponents on either side, EPP and P/D have both proven to improve patient life expectancy significantly. Like the EPP, P/D also doubles the average patient life expectancy.
Cytoreduction: First, the surgeon uses a surgical technique called cytoreduction. The surgeon removes as much of the visible tumors as possible, as well as removing the diseased peritoneum (peritonectomy) — the lining of the abdominal cavity.
HIPEC: The surgeon then applies hyperthermic intraoperative chemotherapy (HIPEC) — circulating heated chemotherapy drugs in the abdomen. HIPEC helps kill off any remaining mesothelioma cells in the abdomen. Dr. Paul Sugarbaker developed this operation for peritoneal mesothelioma.
Did you know?
Cytoreduction with HIPEC has resulted in an average life expectancy of three years for patients.
Pericardiectomy is used to treat pericardial mesothelioma. During a pericardiectomy, the surgeon removes part or all of the diseased pericardium, the lining of the heart.
Combining a pericardiectomy with chemotherapy has allowed some patients to live longer than three years after their diagnosis.
A pericardiectomy may be used as a treatment surgery or a palliative surgery to help alleviate painful symptoms like difficulty breathing. In some cases, a pericardiectomy has extended a patient’s life expectancy significantly.
Palliative surgeries help increase comfort levels by alleviating symptoms. There are many types of palliative surgeries, depending on the mesothelioma location.
Most palliative surgeries involve removing parts of the diseased mesothelium and draining fluid buildup. Draining fluid helps patients by reducing their swelling and eliminating tightness in their chest or abdomen. This allows them to breathe comfortably.
Palliative surgeries don’t usually extend life expectancy, but they can help mesothelioma patients live without pain and discomfort.
Here are the different palliative surgical options:
Pleurodesis: Prevents fluid buildup in the pleura
Thoracentesis: Removes excess fluid between the lungs and the pleura
Pericardiocentesis: Empties excess fluid in the pericardium
Mesothelioma specialists are the only ones who can adequately determine whether a patient is a good candidate for curative surgeries or palliative surgeries.
Chemotherapy is the most common form of treatment for mesothelioma. It involves regularly administering an anti-cancer drug to the patient.
Did you know?
Patients are given chemotherapy drugs in cycles, typically administered intravenously in a three-hour session every three weeks. Patients usually receive 3-4 rounds of chemotherapy.
Chemotherapy can also be taken in pill form. There are many kinds of chemotherapy drugs, but mesothelioma patients usually take a combination of pemetrexed and cisplatin along with other medications.
Chemotherapy drugs work to stop cancer cells from multiplying, which helps slow the disease progression. Mesothelioma specialists often combine chemotherapy with surgical procedures. Chemotherapy drugs help kill remaining cancer cells that surgeons weren’t able to remove.
Chemotherapy can be given before (neoadjuvant) or after (adjuvant) surgical procedures. It may also produce side effects like hair loss and fatigue. Before starting your medication plan, discuss with your doctor the options for minimizing chemotherapy side effects.
Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. It can help patients no matter what type or stage of mesothelioma they have. A specialized doctor called a radiologist maps out the location of malignant tumors.
Radiation interferes with the DNA of mesothelioma cells, preventing them from multiplying or spreading. This slows the cancer’s progression.
Radiation can be administered non-invasively (through the skin) using external beams. Radiotherapy can also be administered intraoperatively, which is when it is delivered directly to tumors during open surgery.
Radiotherapy is often used in addition to other treatments and is commonly part of multimodal therapy.
Mesothelioma treatments require specialized knowledge, which is why it’s critical to receive treatment from a mesothelioma specialist as opposed to a general oncologist.
Specialists can put together a tailored treatment plan that addresses each unique patient case. A custom treatment plan gives patients a better chance of survival.
The veteran’s VA Health Care Network and cancer centers across the U.S. are home to some of the world’s top mesothelioma specialists.
It’s vital to work with a mesothelioma specialist at a designated mesothelioma cancer center. Mesothelioma specialists and cancer centers are the best way to ensure you get the best chance of extending your life expectancy and improving your quality of life.
Contact any of the following mesothelioma cancer centers today or call one of our patient advocates to set up an appointment:
These world-class mesothelioma medical centers understand the financial burdens that patients and their families undergo during a mesothelioma diagnosis. That’s why the administrators work directly with the patient’s insurance provider to ensure that they take care of all of their medical claims.
Not all patients have insurance coverage for their mesothelioma diagnosis. Thankfully, veterans with mesothelioma diagnoses have substantial financial support options that alleviate the burden of medical costs.
Financial support programs for vets with mesothelioma include:
Veterans who developed mesothelioma as a result of their military service are eligible for benefits and financial aid through several different agencies and organizations.
The Department of Veterans Affairs (VA) is one of the most valuable resources for veterans with mesothelioma. The VA connects eligible veterans with mesothelioma treatments. These treatments are sometimes through government-funded clinical trials that provide promising emerging therapies.
Veterans can find financial help for treatment through:
VA-affiliated mesothelioma specialists
Disability benefits and veterans pension
Mesothelioma trust funds for victims of asbestos exposure
If you are a veteran with a mesothelioma diagnosis, you are not alone. There are many resources available that can support your treatment and recovery. To learn more about your options, contact our VA claims agents today.
Double Board-Certified Oncologist and Hematologist
Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.
Dr. Todd Gersten is an independently paid medical reviewer.
Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.